A fabric-based multifunctional sensor for the early detection of skin decubitus ulcers

Seung Rok Kim; Soyeon Lee; Jihee Kim; Eunbin Kim; Hye Jun Kil; Ju Hyun Yoo; Je Heon Oh; Jiwan Jeon; Ey In Lee; Jun Woo Jeon; Kun Hoo Jeon; Ju Hee Lee; Jin Woo Park

doi:10.1016/j.bios.2022.114555

A fabric-based multifunctional sensor for the early detection of skin decubitus ulcers

Seung Rok Kim, Soyeon Lee, Jihee Kim, Eunbin Kim, Hye Jun Kil, Ju Hyun Yoo, Je Heon Oh, Jiwan Jeon, Ey In Lee, Jun Woo Jeon, Kun Hoo Jeon, Ju Hee Lee, Jin Woo Park

Research output: Contribution to journal › Article › peer-review

1 Citation (Scopus)

Abstract

Monitoring biosignals at the skin interface is necessary to suppress the potential for decubitus ulcers in immobile patients confined to bed. We develop conformally contacted, disposable, and breathable fabric-based electronic devices to detect skin impedance, applied pressure, and temperature, simultaneously. Based on the experimental evaluation of the multifunctional sensors, a combination of robust AgNW electrodes, soft ionogel capacitive pressure sensor, and resistive temperature sensor on fabric provides alarmed the initiation of early-stage decubitus ulcers without signal distortion under the external stimulus. For clinical verification, an animal model is established with a pair of magnets to mimic a human decubitus ulcers model in murine in vivo. The evidence of pressure-induced ischemic injury is confirmed with the naked eye and histological and molecular biomarker analyses. Our multifunctional integrated sensor detects the critical time for early-stage decubitus ulcer, establishing a robust correlation with the biophysical parameters of skin ischemia and integrity, including temperature and impedance.

Original language	English
Article number	114555
Journal	Biosensors and Bioelectronics
Volume	215
DOIs	https://doi.org/10.1016/j.bios.2022.114555
Publication status	Published - 2022 Nov 1

Bibliographical note

Funding Information:
This work was supported by Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT , the Ministry of Trade, Industry and Energy , the Ministry of Health & Welfare, the Ministry of Food and Drug Safety ) (Project Number: 1711138212 , KMDF_PR_20200901_0116 ), National Research Foundation of Korea(NRF) grant funded by the Korea government(MSIT) (No. 2021R1A2C2004297 ), and National Research Foundation of Korea(NRF) grant funded by the Korean government(MSIT) (No. NRF-2021R1A4A1032129 ).

Funding Information:
The National Pressure Injury Advisory Panel (NPIAP) (Kottner et al., 2019) advises caregivers to periodically change the body position of patients(Oh et al., 2021), to provide nutrition and supporting surfaces.(Kottner et al., 2019). For example, exploiting automatically adjustable pressure sensing mattresses can be a preventive method for chronic pressure ulcer.(Kim and Hong, 2020; Lee et al., 2019). However, this action is highly labor intensive(Ayello and Lyder, 2008; Swisher et al., 2015), and pressure sensing alone cannot detect the early stage of tissue damage.(Swisher et al., 2015). Among the developmental processes of skin ulcers shown in Fig. 1b (Bansal et al. 2005), detecting a Stage I ulcer is crucial because the underlying tissue damage is already severe by the time skin damage becomes discernible with the naked eye (in Stage II).(Ayello and Lyder, 2008; Kruanopparat, 2021; Swisher et al., 2015). Once an ulcer reaches Stage II, the progression of the ulcer to Stages III and IV becomes very rapid, and, in some cases, surgery can be considered for patients who suffer from diabetes mellitus, hemophilia, or drug taker. Therefore, clinically relevant biosignals should be defined to proactively detect decubitus ulcers in Stage I using timely information.(Swisher et al., 2015; Tang et al., 2021). Furthermore, in the areas of the bony protuberance, pressure load may cause deep tissue damage with a greater extent of tissue injury with lesser visible superficial skin changes.(Kottner et al., 2019). Such stages are referred to as ‘deep tissue injury’ or ‘deep pressure injury,’ where the wound may evolve rapidly in the bone-muscle interface. Clinically, advanced-stage pressure ulcers often present in variable phenotypes with unidentifiable degrees of ulceration with slough tissue or eschar (Fig. 1b). (Kottner et al., 2019)This work was supported by Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety) (Project Number: 1711138212, KMDF_PR_20200901_0116), National Research Foundation of Korea(NRF) grant funded by the Korea government(MSIT) (No. 2021R1A2C2004297), and National Research Foundation of Korea(NRF) grant funded by the Korean government(MSIT) (No. NRF-2021R1A4A1032129).

Publisher Copyright:
© 2022 Elsevier B.V.

All Science Journal Classification (ASJC) codes

Biotechnology
Biophysics
Biomedical Engineering
Electrochemistry

Access to Document

10.1016/j.bios.2022.114555

Cite this

@article{0bc9ebd70ae34d2d84adf8edf4c59fd1,

title = "A fabric-based multifunctional sensor for the early detection of skin decubitus ulcers",

abstract = "Monitoring biosignals at the skin interface is necessary to suppress the potential for decubitus ulcers in immobile patients confined to bed. We develop conformally contacted, disposable, and breathable fabric-based electronic devices to detect skin impedance, applied pressure, and temperature, simultaneously. Based on the experimental evaluation of the multifunctional sensors, a combination of robust AgNW electrodes, soft ionogel capacitive pressure sensor, and resistive temperature sensor on fabric provides alarmed the initiation of early-stage decubitus ulcers without signal distortion under the external stimulus. For clinical verification, an animal model is established with a pair of magnets to mimic a human decubitus ulcers model in murine in vivo. The evidence of pressure-induced ischemic injury is confirmed with the naked eye and histological and molecular biomarker analyses. Our multifunctional integrated sensor detects the critical time for early-stage decubitus ulcer, establishing a robust correlation with the biophysical parameters of skin ischemia and integrity, including temperature and impedance.",

author = "Kim, {Seung Rok} and Soyeon Lee and Jihee Kim and Eunbin Kim and Kil, {Hye Jun} and Yoo, {Ju Hyun} and Oh, {Je Heon} and Jiwan Jeon and Lee, {Ey In} and Jeon, {Jun Woo} and Jeon, {Kun Hoo} and Lee, {Ju Hee} and Park, {Jin Woo}",

note = "Funding Information: This work was supported by Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT , the Ministry of Trade, Industry and Energy , the Ministry of Health & Welfare, the Ministry of Food and Drug Safety ) (Project Number: 1711138212 , KMDF_PR_20200901_0116 ), National Research Foundation of Korea(NRF) grant funded by the Korea government(MSIT) (No. 2021R1A2C2004297 ), and National Research Foundation of Korea(NRF) grant funded by the Korean government(MSIT) (No. NRF-2021R1A4A1032129 ). Funding Information: The National Pressure Injury Advisory Panel (NPIAP) (Kottner et al., 2019) advises caregivers to periodically change the body position of patients(Oh et al., 2021), to provide nutrition and supporting surfaces.(Kottner et al., 2019). For example, exploiting automatically adjustable pressure sensing mattresses can be a preventive method for chronic pressure ulcer.(Kim and Hong, 2020; Lee et al., 2019). However, this action is highly labor intensive(Ayello and Lyder, 2008; Swisher et al., 2015), and pressure sensing alone cannot detect the early stage of tissue damage.(Swisher et al., 2015). Among the developmental processes of skin ulcers shown in Fig. 1b (Bansal et al. 2005), detecting a Stage I ulcer is crucial because the underlying tissue damage is already severe by the time skin damage becomes discernible with the naked eye (in Stage II).(Ayello and Lyder, 2008; Kruanopparat, 2021; Swisher et al., 2015). Once an ulcer reaches Stage II, the progression of the ulcer to Stages III and IV becomes very rapid, and, in some cases, surgery can be considered for patients who suffer from diabetes mellitus, hemophilia, or drug taker. Therefore, clinically relevant biosignals should be defined to proactively detect decubitus ulcers in Stage I using timely information.(Swisher et al., 2015; Tang et al., 2021). Furthermore, in the areas of the bony protuberance, pressure load may cause deep tissue damage with a greater extent of tissue injury with lesser visible superficial skin changes.(Kottner et al., 2019). Such stages are referred to as {\textquoteleft}deep tissue injury{\textquoteright} or {\textquoteleft}deep pressure injury,{\textquoteright} where the wound may evolve rapidly in the bone-muscle interface. Clinically, advanced-stage pressure ulcers often present in variable phenotypes with unidentifiable degrees of ulceration with slough tissue or eschar (Fig. 1b). (Kottner et al., 2019)This work was supported by Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety) (Project Number: 1711138212, KMDF_PR_20200901_0116), National Research Foundation of Korea(NRF) grant funded by the Korea government(MSIT) (No. 2021R1A2C2004297), and National Research Foundation of Korea(NRF) grant funded by the Korean government(MSIT) (No. NRF-2021R1A4A1032129). Publisher Copyright: {\textcopyright} 2022 Elsevier B.V.",

year = "2022",

month = nov,

day = "1",

doi = "10.1016/j.bios.2022.114555",

language = "English",

volume = "215",

journal = "Biosensors and Bioelectronics",

issn = "0956-5663",

publisher = "Elsevier Limited",

}

TY - JOUR

T1 - A fabric-based multifunctional sensor for the early detection of skin decubitus ulcers

AU - Kim, Seung Rok

AU - Lee, Soyeon

AU - Kim, Jihee

AU - Kim, Eunbin

AU - Kil, Hye Jun

AU - Yoo, Ju Hyun

AU - Oh, Je Heon

AU - Jeon, Jiwan

AU - Lee, Ey In

AU - Jeon, Jun Woo

AU - Jeon, Kun Hoo

AU - Lee, Ju Hee

AU - Park, Jin Woo

N1 - Funding Information: This work was supported by Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT , the Ministry of Trade, Industry and Energy , the Ministry of Health & Welfare, the Ministry of Food and Drug Safety ) (Project Number: 1711138212 , KMDF_PR_20200901_0116 ), National Research Foundation of Korea(NRF) grant funded by the Korea government(MSIT) (No. 2021R1A2C2004297 ), and National Research Foundation of Korea(NRF) grant funded by the Korean government(MSIT) (No. NRF-2021R1A4A1032129 ). Funding Information: The National Pressure Injury Advisory Panel (NPIAP) (Kottner et al., 2019) advises caregivers to periodically change the body position of patients(Oh et al., 2021), to provide nutrition and supporting surfaces.(Kottner et al., 2019). For example, exploiting automatically adjustable pressure sensing mattresses can be a preventive method for chronic pressure ulcer.(Kim and Hong, 2020; Lee et al., 2019). However, this action is highly labor intensive(Ayello and Lyder, 2008; Swisher et al., 2015), and pressure sensing alone cannot detect the early stage of tissue damage.(Swisher et al., 2015). Among the developmental processes of skin ulcers shown in Fig. 1b (Bansal et al. 2005), detecting a Stage I ulcer is crucial because the underlying tissue damage is already severe by the time skin damage becomes discernible with the naked eye (in Stage II).(Ayello and Lyder, 2008; Kruanopparat, 2021; Swisher et al., 2015). Once an ulcer reaches Stage II, the progression of the ulcer to Stages III and IV becomes very rapid, and, in some cases, surgery can be considered for patients who suffer from diabetes mellitus, hemophilia, or drug taker. Therefore, clinically relevant biosignals should be defined to proactively detect decubitus ulcers in Stage I using timely information.(Swisher et al., 2015; Tang et al., 2021). Furthermore, in the areas of the bony protuberance, pressure load may cause deep tissue damage with a greater extent of tissue injury with lesser visible superficial skin changes.(Kottner et al., 2019). Such stages are referred to as ‘deep tissue injury’ or ‘deep pressure injury,’ where the wound may evolve rapidly in the bone-muscle interface. Clinically, advanced-stage pressure ulcers often present in variable phenotypes with unidentifiable degrees of ulceration with slough tissue or eschar (Fig. 1b). (Kottner et al., 2019)This work was supported by Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety) (Project Number: 1711138212, KMDF_PR_20200901_0116), National Research Foundation of Korea(NRF) grant funded by the Korea government(MSIT) (No. 2021R1A2C2004297), and National Research Foundation of Korea(NRF) grant funded by the Korean government(MSIT) (No. NRF-2021R1A4A1032129). Publisher Copyright: © 2022 Elsevier B.V.

PY - 2022/11/1

Y1 - 2022/11/1

N2 - Monitoring biosignals at the skin interface is necessary to suppress the potential for decubitus ulcers in immobile patients confined to bed. We develop conformally contacted, disposable, and breathable fabric-based electronic devices to detect skin impedance, applied pressure, and temperature, simultaneously. Based on the experimental evaluation of the multifunctional sensors, a combination of robust AgNW electrodes, soft ionogel capacitive pressure sensor, and resistive temperature sensor on fabric provides alarmed the initiation of early-stage decubitus ulcers without signal distortion under the external stimulus. For clinical verification, an animal model is established with a pair of magnets to mimic a human decubitus ulcers model in murine in vivo. The evidence of pressure-induced ischemic injury is confirmed with the naked eye and histological and molecular biomarker analyses. Our multifunctional integrated sensor detects the critical time for early-stage decubitus ulcer, establishing a robust correlation with the biophysical parameters of skin ischemia and integrity, including temperature and impedance.

AB - Monitoring biosignals at the skin interface is necessary to suppress the potential for decubitus ulcers in immobile patients confined to bed. We develop conformally contacted, disposable, and breathable fabric-based electronic devices to detect skin impedance, applied pressure, and temperature, simultaneously. Based on the experimental evaluation of the multifunctional sensors, a combination of robust AgNW electrodes, soft ionogel capacitive pressure sensor, and resistive temperature sensor on fabric provides alarmed the initiation of early-stage decubitus ulcers without signal distortion under the external stimulus. For clinical verification, an animal model is established with a pair of magnets to mimic a human decubitus ulcers model in murine in vivo. The evidence of pressure-induced ischemic injury is confirmed with the naked eye and histological and molecular biomarker analyses. Our multifunctional integrated sensor detects the critical time for early-stage decubitus ulcer, establishing a robust correlation with the biophysical parameters of skin ischemia and integrity, including temperature and impedance.

UR - http://www.scopus.com/inward/record.url?scp=85134434253&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85134434253&partnerID=8YFLogxK

U2 - 10.1016/j.bios.2022.114555

DO - 10.1016/j.bios.2022.114555

M3 - Article

C2 - 35863135

AN - SCOPUS:85134434253

SN - 0956-5663

VL - 215

JO - Biosensors and Bioelectronics

JF - Biosensors and Bioelectronics

M1 - 114555

ER -

A fabric-based multifunctional sensor for the early detection of skin decubitus ulcers

Abstract

Bibliographical note

All Science Journal Classification (ASJC) codes

Access to Document

Other files and links

Fingerprint

Cite this